Goal: Test a Human Factors paradigm to improve efficacy and safety in medical care domains that are accident-prone. The test domain will be pediatric procedural sedation--the treatment of procedure related pain and stress with medication in children. Specific Aims: 1) identify pediatric procedural sedation care system hazards; 2) model modes of failure in the practice of pediatric procedural sedation; 3) innovate error prevention, error recovery and error tolerance strategies for pediatric sedation care systems. Research Design: 1) Simulate two sedation associated events that carry the potential for serious injury or death. Scenarios will be reproducible using a pediatric simulator (Ped-sim TM, Medical Education Technologies, Inc.). Airway obstruction and central apnea are the two sedation events that will be embedded into typical sedation contexts. 2) Study the performance of four Anesthesiology) managing one scenario without an event, one scenario with airway obstruction and one scenario with central apnea. Simulated cases will be assigned using standard scheduling systems and care will be videotaped. 3) Video analysis to identify hazards and vulnerabilities associated with pediatric sedation. Video and verbal data will be used to perform a work analysis in order to define the operators, environment, technology, and patient demands that characterize pediatric sedation when managing sedation associated respiratory events. Qualitative methods (protocol analysis, process tracing and hazards analysis) and semi-quantitative methods (that measure operative conditions, response times, accuracy rates, simulator hypoxia of PaO2 < 27 in seconds) of analysis will be employed. 4) Engineering safety into sedation care systems. The goal is to iteratively design novel "best practices for sedation care that not only prevent error, but also create error tolerance and error recovery at the system level Hazards identified in steps 1-3 will be the focal point of design efforts.